Canadian Journal of Anesthesia

, Volume 48, Issue 5, pp 478–482 | Cite as

Separation of omphalopagus conjoined twins using combined caudal epidural — general anesthesia

  • Mark Greenberg
  • David D. Frankville
  • Mary Hilfiker
Obstetrical and Pediatric Anesthesia



To describe the anesthetic management of newborn omphalopagus conjoined twins undergoing a series of diagnostic and surgical procedures which culminated in successful separation at one month of age.

Clinical features

Evaluations of the extent of shared organ systems were carried out without the need for anesthesia. The twins were anesthetized twice, once for insertion of skin expanders, and later for surgical separation. Various airway management techniques were utilized. To facilitate surgical separation, caudal epidural catheters were inserted in an effort to provide both operative and post-operative analgesia. In addition, prior to the induction of anesthesia, the extent of cross-circulation between twins was assessed.


Caudal epidural catheters can be used to provide both operative and post-operative analgesia. Early extubation, another benefit of regional analgesia, was not achieved because both twins developed respiratory failure in the immediate post-operative period. Testing for the extent of cross-circulation between twins proved valuable, allowing for detailed scripting of the complex induction sequence and airway management.


Postoperative Analgesia Gastroschisis Glycopyrrolate Nasotracheal Intubation Successful Separation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Décrire la prise en charge anesthésique de jumeaux siamois nouveau-nés, monomphaliens, séparés avec succès à l’âge d’un mois à la suite d’une série d’interventions diagnostiques et chirurgicales.

Éléments cliniques

Les mesures de l’importance des systèmes organiques partagés ont pu être réalisées sans recourir à l’anesthésie. Les jumeaux ont été anesthésiés à deux reprises, pour l’insertion d’expanseurs cutanés et pour la séparation chirurgicale. On a utilisé différentes techniques pour le contrôle des voies respiratoires. Dans le but de faciliter la séparation chirurgicale, des cathéters caudaux ont été insérés pour assurer une analgésie opératoire et postopératoire. De plus, avant l’induction de l’anesthésie, l’ampleur de la circulation croisée entre les jumeaux a été évaluée.


Le cathéter caudal peut être utilisé pour fournir autant l’analgésie opératoire que postopératoire. L’extubation précoce, un autre avantage de l’analgésie régionale, n’a pas été réalisée parce qu’une insuffisance respiratoire s’est développée immédiatement immédiatement après l’intervention chirurgicale. L’évaluation de l’ampleur de la circulation croisée a été précieuse en ce qu’elle a fournit une démarche structurée pour l’induction complexe et la maîtrise des voies aériennes.


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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Mark Greenberg
    • 1
  • David D. Frankville
    • 1
  • Mary Hilfiker
    • 2
  1. 1.Department of AnesthesiologyUniversity of California at San Diego, UCSD Medical CenterSan DiegoUSA
  2. 2.Department of Pediatric SurgeryUniversity of California at San DiegoCaliforniaUSA

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